Wed. Aug 10th, 2022
    Lung cancer carcinoma

    Lung Cancer

    Lung cancer starts in the cells of the lung. Cancerous (malignant) tumor is a group of cancer cells that can invade and destroy nearby tissue. It can also spread (metastasize) to other parts of the body. When cancer starts in the cells of the lung, it is called primary lung cancer.

    The lung is part of the respiratory system. You use your lungs when you breathe. The lungs are located in the thorax on either side of the heart. The right lung is made up of 3 main sections called lobes. The left lung, a little smaller, has 2 lobes. The lungs are surrounded by a thin protective membrane called the pleura, which acts as a kind of cushion for these organs.

    Other types of cancer can spread to the lung, but this is a different disease from primary lung cancer. Cancer that starts in another part of the body and spreads to the lung is called lung metastasis; this is treated differently from primary lung cancer.

    A rare type of cancer, pleural mesothelioma, is often mistakenly called lung cancer. Although mesothelioma starts in the pleura that covers the lung, it is very different from cancer that starts in the lung.

    Symptoms of lung cancer

    Symptoms of lung cancer include a cough that gets worse or persists and constant chest pain.

    Sometime this cancer may not cause any signs or symptoms in the very early stages of the disease. Signs and symptoms often appear as the tumor grows and causes changes in the body such as coughing or shortness of breath. Other medical conditions can cause the same symptoms as this cancer.

    Many of the signs or symptoms of non-small cell lung cancer and small cell lung cancer are the same. See your doctor if you have the following signs or symptoms of both types of lung cancer:

    • cough that gets worse or does not go away
    • shortness of breath
    • chest pain that you have constantly that gets worse when you take a deep breath or cough
    • blood in the mucus expelled from the lungs when you cough
    • wheezing
    • weightloss
    • tired
    • hoarseness or other changes that affect your voice
    • difficulty swallowing
    • swollen lymph nodes in the neck or above the collarbone
    • headache

    Non-small cell
    It can cause Horner syndrome. This is a collection of symptoms caused by lung cancer that has invaded the nerves on the top of the lung. If you are experiencing this set of symptoms, see your doctor:

    eye changes – drooping eyelid or narrowing of the pupil
    no or very weak sweating on the side of the face where the eye has changed

    Small cell
    Paraneoplastic syndrome is a set of symptoms that occurs when substances released by cancer cells disrupt the normal function of other organs or tissues. Small cell lung cancer is more likely to cause paraneoplastic syndrome than non-small cell lung cancer.

    If you experience any of these sets of symptoms, see your doctor:

    Syndrome of inappropriate antidiuretic hormone secretion (SIADH) occurs when the body makes too much antidiuretic hormone (ADH). This hormone helps the kidneys control the amount of water your body loses through the urine. SIADH causes the body to retain too much water.

    Cushing’s syndrome occurs when the body makes a large amount of corticosteroids. Symptoms of Cushing’s syndrome include high blood pressure, high blood sugar, a round face as well as lean arms and legs and muscle weakness. It can also cause weight gain which causes purple markings to appear on the stomach.

    Lambert-Eaton syndrome is caused by the absence of a chemical that transmits messages between muscles and nerves. Symptoms of Lambert-Eaton syndrome include muscle weakness, loss of movement, and difficulty chewing, climbing stairs, or lifting objects.

    Paraneoplastic cerebellar degeneration is a very rare paraneoplastic syndrome. It occurs when the immune system reacts abnormally and attacks cells of the central nervous system. Symptoms of this disorder include dizziness, nausea, loss of balance, slightly blurred vision, rapid eye movements, tremors, and difficulty speaking or swallowing.

    When to see your healthcare team
    In some cases, this cancer or its treatment can cause serious problems.

    Superior vena cava compression syndrome occurs when the cancer blocks the large vein (superior vena cava) that brings blood to the head and arms, causing headaches and swelling of the head and neck. . It is a serious emergency due to cancer that must be treated immediately.

    Spinal cord compression occurs when cancer spreads to the spine and compresses the spinal cord, causing back pain, weakness in the legs, or a change in the function of the bladder or blood. ‘intestine. It is a serious emergency due to cancer that must be treated immediately.

    See your healthcare team as soon as possible if you have any symptom of superior vena cava compression syndrome or spinal cord compression.

    Read also: Colon Cancer (Colorectal) | Symptoms, Stages, Types, Diagnoses, Chances of Surviving, Treatments

    Treatments for non-small cell lung cancer

    If you have non-small cell lung cancer, your healthcare team will make a treatment plan just for you. It will be based on your health and specific cancer information. When your healthcare team decides what treatments to offer you for non-small cell lung cancer, they consider the following:

    the stage of cancer
    the possibility of removing the cancer by surgery
    any genetic changes in lung cancer cells
    the presence of an immune checkpoint marker in lung cancer cells
    your overall health, including your lung function
    your personal preferences (whatever you want)
    You may be offered one or more of the following treatments for non-small cell lung cancer.

    Surgery

    Surgery may be used to treat non-small cell lung cancer if it can be completely removed and if you are healthy enough to have an operation. The type of surgery you choose depends on the location of the cancer in the lung. Lymph nodes are removed regardless of the type of surgery performed.

    Wedge resection and segmentectomy remove the tumor as well as a margin of healthy tissue around it.

    Lobectomy involves removing the lobe of the lung where the tumor is located. Bilobectomy is a type of lobectomy that removes 2 of the 3 lobes of the right lung.

    Pneumonectomy involves removing the entire lung.

    Enlarged lung resection removes muscles, nerves, blood vessels and other tissue near the lung to remove cancer that has spread to the chest wall or other tissues around the lung.

    Chest wall resection removes muscle, bone, and other tissue from the chest wall.

    Sleeve resection removes the tumor that is in one of the airways (bronchi) of the lung along with a margin of healthy tissue around it.

    Chemotherapy

    Chemotherapy can be given before or after surgery for non-small cell lung cancer. It can also be used as the main treatment if you are not well enough to have surgery or if you do not want surgery. Chemotherapy may also be given after the main treatment to slow down or prevent the cancer from coming back (maintenance or adjuvant therapy).

    Non-small cell lung cancer is usually treated with a combination of two drugs, which is more effective than giving one drug. The most common chemotherapy drugs used to treat non-small cell lung cancer include cisplatin.

    Radiotherapy

    External beam radiation therapy can be given to treat non-small cell lung cancer if it cannot be removed with surgery, or if you are not well enough to have surgery, or if you do not want it. It may also be used after surgery for stage 3A non-small cell lung cancer.

    There are several different types of external beam radiation therapy for non-small cell lung cancer, including three-dimensional conformational radiation therapy (3D CR), intensity-modulated conformational radiation therapy (IMRG), and stereotaxic body radiation therapy (CSS).

    If you cannot receive external beam radiation therapy because of lung problems, you may be offered brachytherapy to treat a tumor that is blocking an airway in the lung. Brachytherapy is a type of internal radiation therapy that uses radiation emitted by radioactive material inserted into the body to destroy cancer cells.

    Chemoradiotherapy

    Chemotherapy is sometimes combined with radiation therapy to treat non-small cell lung cancer. This is called chemoradiation. These 2 treatments are administered during the same period. Chemoradiation is only offered if you are healthy enough to have both treatments at the same time.

    Targeted treatment

    Targeted therapy uses drugs to target specific molecules, such as proteins, found on the surface or inside of cancer cells. Targeted therapy is offered instead of chemotherapy for non-small cell lung cancer that has spread to the lymph nodes or other parts of the body or that has come back after chemotherapy treatments.

    The type of target drug given depends on the type of genetic change seen in the diagnosis from studies of cells and tissues. Some of the targeted drugs used for non-small cell lung cancer are gefitinib (Iressa), crizotinib (Xalkori), alectinib (Alecensaro), and larotrectinib (Vitrakvi).

    Immunotherapy

    Immunotherapy helps strengthen or restore the ability of the immune system to fight cancer. It is used for non-small cell lung cancer that is advanced or metastatic after it stops responding to chemotherapy or targeted therapy. The type of immunotherapeutic drug offered depends on the types of changes seen in cancer cells during cell and tissue studies. Some of the immunotherapeutic drugs used for non-small cell lung cancer include pembrolizumab (Keytruda) and nivolumab (Opdivo).

    Endobronchial treatments

    Endobronchial therapy is used to clear a blockage caused by cancer inside the lung and helps relieve symptoms such as trouble breathing, pain, and bloody cough. There are different types of endobronchial treatments.

    Endobronchial treatments may also be used to treat non-small cell lung cancer if you cannot have surgery or radiation therapy.

    Smoking cessation
    If you smoke, it is important that you quit smoking before surgery, chemotherapy, or radiation therapy. Research shows that people who quit smoking before treatment for lung cancer are more likely to live longer and reduce their risk of experiencing treatment-related side effects and developing another Cancer.

    Causes

    The main cause is smoking (cigarettes, pipes, or cigars), although not everyone who smokes will develop this cancer. Harmful substances in cigarettes, damage lung cells. Inhaling smoke as secondhand smoke, can also cause it in some people who don’t smoke.

    You may also be at risk for this cancer if you:

    Smoke. Cigarettes contain more than 60 types of carcinogens, including radioisotopes from the decay sequences of radon, nitrosamines and benzopirene.
    Over 40 years of age, most people are over 65 years of age, when diagnosed with lung cancer.
    Contact with some substances, such as radon (radioactive gas), asbestos, arsenic, chromium, nickel and air pollution.
    Have a family member who has lung cancer.

    Diagnosis of lung cancer

    Lung cancer diagnostic tests are done when common symptoms or tests point to a disorder. Learn about the diagnosis.

    Diagnosis is the process of identifying the cause of a health problem. The diagnostic process for lung cancer usually begins with a visit to your family doctor. Your doctor will ask you about your symptoms and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for lung cancer or other health problems.

    The diagnostic process can seem long and overwhelming. It’s okay to worry, but try to remember that other medical conditions can cause lung cancer-like symptoms. It is important that the healthcare team rule out any other possible cause of the health problem before making a diagnosis of lung cancer.

    The following tests are usually used to rule out or diagnose lung cancer. Many tests that can diagnose cancer are also used to determine the stage, that is, how far the disease has spread. Your doctor may also give you other tests to check your general health and help plan your treatment.

    Health history and physical examination

    Your health history consists of a checkup of your symptoms, your risks, and any medical events and conditions you may have had in the past. Your doctor will ask you questions about your history:

    • symptoms that suggest lung cancer
    • smoking
    • secondhand smoke inhalation
    • exposure to gas called radon
    • asbestos exposure at work

    Your doctor may also ask you questions about your family history:

    • lung cancer
    • other cancers

    The physical exam allows your doctor to look for any signs of lung cancer. During the physical exam, your doctor may:

    • listen to your lungs and heart using a stethoscope;
    • pat your chest to hear noises;
    • feel your neck and the area above the collarbones for swelling or larger than normal lymph nodes
    • feel your abdomen to see if your liver is larger than normal.
    • check your blood pressure and pulse;
    • check if you have lost weight.
    Complete blood count

    The complete blood count is used to assess the quantity and quality of white blood cells, red blood cells and platelets. A CHF is done to get basic information about your overall health before treatment begins.

    X-ray

    In an x-ray, low-dose radiation is used to produce images of parts of the body on film. A chest x-ray is often the first imaging test done to check for lung problems. It can reveal spots, tumors, or changes.

    CT scan

    A computed tomography (CT) scan uses special x-ray machines to produce 3-dimensional and cross-sectional images of the body’s organs, tissues, bones and blood vessels. A computer assembles the photos into detailed images.

    CT allows you to? :

    reveal the location, size and shape of a lung tumor;
    find any thoracic lymph nodes that are larger than normal
    find out if the tumor has spread to other parts of the body
    guide a biopsy.

    Positron emission tomography

    A positron emission tomography (PET) scan uses a radioactive material called a radiopharmaceutical to detect changes in the metabolic activity of body tissues. A computer analyzes patterns of radioactivity distribution and produces 3-dimensional, color images of the region under investigation.

    A PET is used to find out how far the lung cancer has spread. The camera takes images of the whole body; PET can find tumors that are larger than 8 mm. It is more accurate than a CT scan to show if the cancer has spread to the lymph nodes in the middle of the chest (mediastinum) and to other areas of the body. PET is not used to look at the brain because the brain has high metabolic activity.

    Magnetic resonance imaging

    Magnetic resonance imaging (MRI) uses powerful magnetic forces and radio waves to produce cross-sectional images of the body’s organs, tissues, bones, and blood vessels. A computer assembles the images into 3-dimensional snapshots.

    MRI scans the brain to see if cancer has spread to it. It can also be used to observe the heart before surgery to check whether cancer has invaded the heart or the large blood vessels and nerves at the top of the lung.

    Ultrasound

    In an ultrasound, high-frequency sound waves are used to produce images of parts of the body. Ultrasound can be used to find out if fluid has accumulated around the lungs and to direct a biopsy or discharge of fluid into the chest cavity. Ultrasound is also used to guide a biopsy during endoscopic procedures.

    Bone scan

    In a bone scan, radioactive materials that attach to the bones (radiopharmaceuticals) and a computer are used to create an image of the bones. It is used in people who have bone pain or if blood chemistry tests suggest the cancer has spread to the bones.

    Biopsy

    During a biopsy, the doctor removes tissues or cells from the body for analysis in the laboratory. It is important to collect enough tissue during the biopsy so that cell and tissue analyzes can be done. The pathologist’s report confirms whether or not there are cancer cells in the sample.

    A fine needle biopsy (BAF) uses a very fine needle and syringe to remove cells, tissue, or fluid from an abnormal area of ​​the body or from a lump. It can be used to diagnose lung cancer. BAF is done during an endoscopy to take samples from the lymph nodes between the lungs. It can also be used to take samples from what could be a tumor in the outer part of the lungs. The needle is inserted into the skin of the chest and directed to the area in question during a CT scan to remove tissue.

    A core biopsy is like a BAF, except that a larger needle is used to remove tissue. A core biopsy removes more tissue than BAF, which helps diagnose and establish the type of lung cancer.

    Thoracentesis is a procedure in which a needle is used to remove fluid from around the lungs. This fluid is examined to see if it contains cancer cells.

    A surgical biopsy removes a piece of tissue from the lung for examination. This biopsy is done through a cut (incision) made between the ribs.

    Endoscopy

    Endoscopy is used to take tissue samples and to find out how far the cancer has spread. It allows the doctor to observe the inside of the body using a flexible or rigid tube with a light and a lens at one end. This tool is called an endoscope. Different types of endoscopy are done to diagnose and stage lung cancer. Each of these procedures is performed separately or during lung cancer surgery.

    A bronchoscopy is done to look inside the lungs for a tumor or blockage. Special bronchoscopes equipped with an ultrasound sensor (endobronchial ultrasound, or EEB) make it possible to take a biopsy of the lymph nodes located near the trachea and the bronchi in order to make a diagnosis or to know if the cancer has spread to the lymph nodes. Lymph nodes can also be sampled using an ultrasound sensor inserted into the esophagus.

    A mediastinoscopy is done to look at the area between the lungs called the mediastinum. Lymph nodes and other tissue near the trachea may be removed during this procedure. Mediastinoscopy is only used if the EBE result is negative but there is still doubt about the presence of cancer in the lymph nodes.

    A thoracoscopy is done to look at the inside of the chest cavity, including the chest wall, lining of the lungs, and lymph nodes in the chest. It may be used if other tests do not collect enough tissue to make a diagnosis.

    Cell and Tissue Studies

    Cells and tissues are analyzed in the laboratory for cancer. The pathologist’s report confirms whether or not there are cancer cells in the sample and indicates the type of lung cancer.

    Molecular analyzes of tissues can detect certain changes (mutations) in the genes of lung cancer cells. These changes affect the type of treatment given. Specific targeted drugs are used for specific genetic mutations. Molecular analyzes of tissue from lung cancer are used to look for the following genetic changes.

    Epidermal Growth Factor Receptor (R-EGF) is a protein found on the surface of cells that helps them grow. Changes in the R-EGF gene can cause the amount of R-EGF to be higher than normal in some types of lung cancer. It is the molecular analysis of tissue that is most often used in the presence of lung cancer.

    Anaplastic lymphoma kinase (ALK) is a mutation of the anaplastic lymphoma kinase gene inside DNA. This gene controls a protein that participates in the growth and division of cells.

    BRAF is a protein that sends signals to cells and helps them grow. Changes in the BRAF gene, or BRAF V600E, may be detected in greater numbers in certain types of lung cancer.

    ROS1 is another protein that sends signals to cells and helps them grow. Changes in the ROS1 gene can be detected in greater numbers than normal in some types of lung cancer.

    The NTRK fusion gene is a fragment of the NTRK gene that has become detached and then linked to another gene. This change causes the formation of abnormal proteins, called TRK fusion proteins, which can promote the growth of cancer cells. NTRK gene fusions are seen in some types of lung cancer.

    Tests of cells and tissues can also look for markers on cancer cells. Some cancer cells make too much of a protein that the immune system uses to differentiate between normal cells and cancer cells. Specific immunotherapeutic drugs are used for specific markers of the immune system.

    The PD-L1 protein helps control the response of the immune system. It is often seen in large amounts on cancer cells, including lung cancer cells. When it binds to another protein called PD-1, it stops T cells in the immune system from destroying cancer cells.

    As new targeted drugs or immunotherapeutics become available to treat lung cancer, other targets may be detected by studying cells and tissues.

    Blood biochemical analyzes

    A blood chemistry test measures the level of chemicals in the blood. It makes it possible to evaluate the quality of functioning of certain organs and also to detect anomalies. It is used to find out if lung cancer has spread to other parts of the body.

    If your alkaline phosphatase (AP), calcium, or phosphorus levels are higher than normal, the cancer has spread to the bones.

    Liver function tests help determine the level of lacticodehydrogenase (LDH), alanine aminotransferase (ALT), aspartate transaminase (AST) and bilirubin. High levels can mean that the cancer has spread to the liver.

    Sputum analysis

    The mucus that is expelled from the lungs when you cough (sputum) can be examined to see if it contains cancer cells. Several sputum samples are taken, usually early in the morning. If you have difficulty expelling this mucus, you may inhale a mist to help it escape.

    A tumor in the large airways of the lung (stem bronchi), squamous cell carcinoma, and a large tumor can leave cancer cells in the sputum.

    Respiratory function tests

    Respiratory function tests tell you how well your lungs are doing. It measures how much air your lungs can hold and your ability to force the air out of your lungs. These tests are important if your doctor is considering surgery as a treatment option for lung cancer. They help make sure that you have sufficient lung capacity after all or part of your lung has been removed.

    An arterial blood test may be done at the same time as the respiratory function tests. A small needle is then used to draw blood from a small artery, usually on the top of the hand or on the wrist. The blood is tested for oxygen and carbon dioxide levels.

    Heart function tests

    Heart function tests tell you how well your heart is performing. These tests are important if your doctor is considering surgery as a treatment option for lung cancer. This will help ensure that your heart is healthy enough for you to have the surgery and recover from it.

    You may have the following heart function tests:

    • echocardiogram (echo)
    • electrocardiogram (ECG)
    • isotope ventriculography or multiple-gated acquisition scan(MUGA)

    Stages

    Staging describes or categorizes cancer based on how much cancer is in the body and where it was initially diagnosed. This is often referred to as the extent of cancer. Information from tests is used to find out how big the tumor is, what parts of the organ have cancer, if the cancer has spread from where it started and where it has spread. Your healthcare team uses the stage to plan your treatment and predict the outcome (your prognosis).

    The most frequently used staging system for non-small cell lung cancer is the TNM staging system. In non-small cell lung cancer, there are 5 stages – stage 0 followed by stages 1 to 4. For stages 1 to 4, the Roman numerals I, II, III and IV are often used. In general, the higher the number, the more cancer has spread. Talk to your doctor if you have questions about staging.

    When doctors describe the stage, they can use the words local, regional, or distant. Local means the cancer is only in the lung and has not spread to other parts of the body. Regional means that the cancer has spread to the lymph nodes or other parts of the chest on the same side of the body as the cancer. Distant means the cancer has spread outside the chest to other parts of the body.

    If cancer cells have been found in the mucus and other substances expelled from the lungs by coughing (sputum) or in the fluid used to wash the lungs but no tumor is found on imaging or bronchoscopy , it is said that lung cancer is occult, that is to say, hidden.

    Stage 0 (carcinoma in situ or adenocarcinoma in situ)

    Cancer cells are seen only in the lining of the airway or air sacs of the lung.

    Stage 1A

    The tumor is in the lung and is 3 cm or less.

    We can thus divide stage 1A:
    Stage 1A1 – The lung tumor is 1 cm or less.
    Stage 1A2 – The lung tumor measures more than 1 cm but not more than 2 cm.
    Stage 1A3 – The lung tumor measures more than 2 cm but not more than 3 cm.

    Stage 1B
    The lung tumor measures more than 3 cm but not more than 4 cm. It can also:

    have invaded the main respiratory tract but not the area where the trachea divides into the left main bronchus and right main bronchus;
    have invaded the internal membrane that covers the lungs, namely the visceral pleura;
    have caused a collapsed lung or blocked a bronchus and caused inflammation of lung tissue (obstructive pneumonitis) in part or all of the lung.

    Stage 2A

    The lung tumor is more than 4 cm but not more than 5 cm or it has:

    invaded the main airway but not the area where the trachea divides into the left main bronchus and right main bronchus;
    invaded the inner membrane that covers the lungs;
    caused a collapsed lung or blocked a bronchus; and caused inflammation of lung tissue in part or all of the lung.
    Stage 2B
    The lung tumor is 5 cm or less and has spread to lymph nodes near the bronchi.

    OR

    One of the following applies:

    The tumor measures more than 5 cm but not more than 7 cm.
    The tumor has invaded the outer membrane that covers the lungs, either the parietal pleura, the chest wall, the main nerve that goes to the diaphragm, or the phrenic nerve, or the outer membrane covering the heart (parietal layer of the pericardium) .
    There are at least 2 tumors in the same lobe of the lung.

    Stage 3A

    The lung tumor is 5 cm or less and has spread to lymph nodes next to the windpipe, on the same side of the body as the tumor, or to lymph nodes below the area where the windpipe divides into a bronchus left strain and right strain bronchus, or to all these ganglia.

    OR

    The tumor is larger than 5 cm and one of the following applies:

    The cancer has spread to the lymph nodes near the bronchi.
    The tumor has grown into one of the following parts of the body: the diaphragm, mediastinum, heart or large blood vessels near the heart, trachea, a major nerve that goes to the larynx, the esophagus, a bone in the spine (vertebra) or the area where the trachea divides into the left main bronchus and right main bronchus.
    There is at least 1 other tumor in the same lung.

    Stage 3B
    The tumor is 5 cm or less and the cancer has spread to lymph nodes on the opposite side of the windpipe or lung or to lymph nodes in the lower part of the neck.

    OR

    The tumor is more than 5 cm or there is at least 1 other tumor in the same lung. The cancer has also spread to the lymph nodes next to the windpipe on the same side of the body as the tumor, or to the lymph nodes below the area where the windpipe divides into the left main bronchus and right main bronchus. , or to all these nodes.

    Stage 3C
    The tumor is more than 5 cm or there is more than 1 tumor in a different lobe of the same lung. The cancer has also spread to lymph nodes on the opposite side of the windpipe or lung or to lymph nodes in the lower part of the neck.

    Stage 4

    The cancer has spread to other parts of the body (distant metastasis). It is also called metastatic non-small cell lung cancer.

    Stage 4A – Any of the following applies:

    The cancer has spread to the other lung.
    The cancer has spread to the pleura or pericardium.
    There is excess fluid in the pleura or pericardium, which is called effusion.
    The cancer has spread and there is 1 new tumor growing outside the chest.
    Stage 4B – The cancer has spread and there are at least 2 tumors growing outside the chest.

    Recurrence
    If non-small cell lung cancer comes back, the cancer comes back after treatment. If it reappears where it first started, it is called a local recurrence. If it reappears in tissues or lymph nodes near where it first started, it is called a regional recurrence. It can also reappear in another part of the body: this is called a recurrence or distant metastasis.

    TNM classification in lung cancer
    TNM classification in lung cancer
    T: Primary tumor
    TXAny of:Primary tumor cannot be assessed
    Tumor cells present in sputum or bronchial washing, but tumor not seen with imaging or bronchoscopy
    T0No evidence of primary tumor
    TisCarcinoma in situ
    T1Tumor size less than or equal to 3 cm across, surrounded by lung or visceral pleura, without invasion proximal to the lobar bronchus
    T1miMinimally invasive adenocarcinoma
    T1aTumor size less than or equal to 1 cm across
    T1bTumor size more than 1 cm but less than or equal to 2 cm across
    T1cTumor size more than 2 cm but less than or equal to 3 cm across
    T2Any of:Tumor size more than 3 cm but less than or equal to 5 cm across
    Involvement of the main bronchus but not the carina
    Invasion of visceral pleura
    Atelectasis/obstructive pneumonitis extending to the hilum
    T2aTumor size more than 3 cm but less than or equal to 4 cm across
    T2bTumor size more than 4 cm but less than or equal to 5 cm across
    T3Any of:Tumor size more than 5 cm but less than or equal to 7 cm across
    Invasion into the chest wall, phrenic nerve, or parietal pericardium
    Separate tumor nodule in the same lobe
    T4Any of:Tumor size more than 7 cm
    Invasion of the diaphragm, mediastinum, heart, great vessels, trachea, carina, recurrent laryngeal nerve, esophagus, or vertebral body
    Separate tumor nodule in a different lobe of the same lung
    N: Lymph nodes
    NXRegional lymph nodes cannot be assessed
    N0No regional lymph node metastasis
    N1Metastasis to ipsilateral peribronchial and/or hilar lymph nodes
    N1aMetastasis to a single N1 nodal station
    N1bMetastasis to two or more N1 nodal stations
    N2Metastasis to ipsilateral mediastinal and/or subcarinal lymph nodes
    N2a1Metastasis to one N2 nodal station with no involvement of N1 nodes
    N2a2Metastasis to one N2 nodal station and at least one N1 nodal station
    N2bMetastasis to two or more N2 nodal stations
    N3Any of:Metastasis to scalene or supraclavicular lymph nodes
    Metastasis to contralateral hilar or mediastinal lymph nodes
    M: Metastasis
    MXDistant metastasis cannot be assessed
    M0No distant metastasis
    M1aAny of:Separate tumor nodule in the other lung
    Tumor with pleural or pericardial nodules
    Malignant pleural or pericardial effusion
    M1bA single metastasis outside the chest
    M1cTwo or more metastases outside the chest

    If lung cancer spreads

    Non-small cell lung cancer cells (NSCLC) have the ability to spread from the lung to other parts of the body where they can form new tumors. This process is called metastasis. New tumors are also called metastasis (singular, if there is only one) or metastasis (plural, if there is more than one).

    Cancer cells can spread from the lungs to other parts of the body. This spread is called metastasis.

    Understanding how a type of cancer used to grow and spread helps your healthcare team plan for your treatment and future care. If lung cancer spreads, can it spread to subsequent parts of the body? :

    • lymph nodes in and around the lung and chest and around the collarbone
    • membranes around the lung, chest, and heart
    • chest wall
    • diaphragm
    • trachea
    • spine
    • other lung
    • esophagus
    • heart
    • adrenal glands
    • liver
    • bone
    • brain

    Supportive care for lung cancer

    Supportive care addresses the physical, practical, emotional and spiritual barriers created by cancer. This important component of cancer care focuses on improving the quality of life for people with cancer and their loved ones, especially after treatment ends.

    Recovering from lung cancer and adjusting to life after treatment is different for everyone. It depends on the location of the cancer in the body, the stage of the cancer, the organs or tissues removed during the surgery, the type of treatment, and many other factors.

    If you have been treated for lung cancer, you may be concerned about the following.

    Cough

    Cough is one of the most common concerns of people with lung cancer at all stages of the disease. Tell your healthcare team if you have a cough or any change to a cough that you have had for a while. Coughing can prevent you from sleeping well and cause you to be very tired. It can even cause vomiting or a broken rib if you cough very hard.

    The cough can be dry and quinty or fatty and productive (sputum). Sometimes the sputum contains blood from the lungs.

    Cough can be caused by the following factors:

    tumor that blocks the airways (bronchi) of a lung;
    accumulation of fluid around the lungs (pleural effusion);
    inflammation of the lung caused by radiation therapy (radiation lung);
    lung infection (pneumonia);
    other existing lung disorders, such as chronic bronchitis, asthma or chronic obstructive pulmonary disease (COPD).
    Treatment depends on the cause of the cough. Treatment options may include endobronchial treatments that aim to clear a blockage in an airway or antibiotics to treat the infection.

    Your healthcare team can give you suggestions that help ease the cough and improve your quality of life, such as:

    • use a humidifier in rooms with dry air;
    • try deep breathing exercises;
    • clear the airways by adopting different positions (postural drainage);
    • use a device to remove mucus from the respiratory tract.

    If other treatments don’t work, your healthcare team may give you opioid medications to help with the cough.

    Difficulty in breathing

    Many people with lung cancer have difficulty breathing and are short of breath. This symptom can be very distressing and it can really affect your quality of life. It can affect work, walking and physical activities, sleep, and other daily activities.

    Tired

    Fatigue is a general lack of energy, fatigue or exhaustion. It differs from the fatigue that a person usually feels at the end of the day. Fatigue is one of the most common side effects of cancer treatment; many people with lung cancer will experience fatigue. Fatigue can be caused by many of the long-term side effects of lung cancer and its treatment, such as coughing, difficulty breathing, and pain.

    Pleural effusion

    Pleural effusion is a buildup of fluid around the lung. This fluid can put pressure on the lung, making it difficult to breathe. Many people with lung cancer will have pleural effusion.

    Weightloss

    One of the most common side effects of lung cancer and its treatment is weight loss. Studies have shown that people with lung cancer who lose a lot of weight do not survive as long as people who keep most of their weight.

    One of the main reasons for losing weight is loss of appetite. Many people with lung cancer lose their appetite because cancer or its treatments can affect the taste of food and make it difficult to eat. If you don’t eat enough, you lose weight.

    Eating well can help your body fight disease and cope with the effects of treatment for lung cancer.

    Blood clots

    People with lung cancer are more likely to have blood clots in the legs (deep vein thrombosis, or DVT) and in the lungs (pulmonary embolism). Your healthcare team may give you medicines that thin the blood to reduce the risk of this happening.

    Post-thoracotomy pain syndrome

    Thoracotomy is a difficult surgery that requires cutting through or bypassing several different tissues in the chest, including skin, muscles, ribs, and nerves. You may experience pain after an open thoracotomy or after less invasive surgery such as video-assisted thoracic surgery (VCT).

    After surgery for lung cancer, many people experience long-term pain where the incisions were made. This is called post-thoracotomy pain syndrome. Many people also experience shoulder pain on the operated side. This type of pain can last for months or even years after surgery.

    The exact cause of post-thoracotomy pain is not known; it is possible that it is due to damage to the nerves or muscles at the time of the surgery. Shoulder pain could be caused by chest drains put in place during the procedure.

    If you are in pain, you may not be able to breathe as deeply as you normally would or cough a lot. Your mobility may also be severely reduced. This can lead to a buildup of mucus in your lungs and possibly a lung infection (pneumonia). Not to mention that pain can also cause fatigue, anxiety or depression. Having chronic pain greatly affects your quality of life.

    Treatment options can be these:

    • taking painkillers
    • injection of anesthetics into different nerves (nerve blockage)

    Tell your healthcare team if you experience pain after your lung cancer surgery.


    List of all Cancers

    The word “cancer” is a generic term for a large group of diseases that can affect any part of the body. We also speak of malignant tumors or neoplasms. One of the hallmarks of cancer is the rapid multiplication of abnormal growing cells, which can invade nearby parts of the body and then migrate to other organs. This is called metastasis, which is the main cause of death from cancer. Types of cancer (in alphabetical order of the area concerned):

    Types of Cancer | List all of Cancers | Adult, Children, Head and neck, Digestive and Types of Blood Cancer


    Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.

    Sources: PinterPandai, NHS UKU.S. Department of Health & Human Services

    Photo credit: Wikimedia Commons

    Photo explainations: From CT -Einzelschichten composite 3D image (the arrow on the carcinoma)